Hidden in plain sight: opioids and chronic pain

Hidden in plain sight: opioids and chronic pain

We are now in danger of an epidemic hitting the UK”. Recent words from Deputy Chief Executive, Duncan Stephenson, of the Royal Society for Public Health after the numbers of people in England using addictive prescribed medicines were revealed for the first time. Mr Stephenson warned that recent figures should serve as a much-needed wake-up call. The Secretary of State for Health and Social Care, Matt Hancock, went one step further, stating that numbers using opiate-based painkillers constituted a “crisis”.

The figures are striking: one in four adults in England – nearly 12 million people – are taking addictive prescription medicines such as antidepressants, sleeping pills and opioids. These figures were published following a review by Public Health England (PHE) that assessed the number of prescriptions issued for five common medicines in England used to treat depression and anxiety, insomnia and chronic pain. Although there were also some encouraging findings, such as a recent fall in the number of prescriptions being given for opioid painkillers, dependence and withdrawal symptoms continue to be a problem associated with these drugs.

Who is this affecting?

The findings reveal that prescribing rates were one and a half times higher for women than men and considerably higher in areas of greater deprivation. The geographic divide was also stark, with nine out of ten of the highest-prescribing areas for opioids in England were in the north (Bristol was the exception).

This shouldn’t come as a surprise after an investigation situated by The Sunday Times, earlier this year, revealed addiction to opioids has ‘spiralled, overdoses have almost doubled, and deaths have rocketed’ as a result. Primarily used for pain relief, opioids also give people a feeling of pleasure that can contribute to psychological dependence and, in extreme cases, potentially lead to fatal overdoses.

Although they are intended to be used for a limited period of time, prescribing habits have been heightened due to increasing workload pressures facing the NHS. The shocking reality is that ‘fewer than one in ten people’ taking opioids for pain will actually experience a reduction in pain.

What is the solution?

PHE has made a number of recommendations to reduce the number of people dependent on addictive medications for which efficacy is negligible, and these fall into three broad categories: data, education and support.

Firstly, PHE calls for steps to increase the availability and utilisation of data relating to the prescribing of medicines. Currently there is no data that shows the conditions for which these drugs are being prescribed, meaning that GPs are unaware if their prescribing practices are in line with other doctors.

Secondly, ensuring that accurate and accessible information is available to patients on the benefits and potential harms of medicines that may cause dependence and withdrawal is vital. Lastly, the review highlights the need to improve the support available from across the healthcare system, including where non-pharmaceutical therapies such as social prescribing can be used as part of a comprehensive treatment plan.

If enforced effectively these proposals could go a long way to decreasing dependency on these drugs.

However, changing the treatment does not resolve the inherent challenge of conditions that are complex and multi-faceted. Pain is a notoriously subjective experience, one that is both difficult to diagnose and appropriately treat, particularly in a standard ten-minute GP consultation. This is compounded by a shortage of pain specialists, waiting times for alternative treatments – such as psychological support services – and questions about the evidence base for other therapies such as social prescribing.

It is these factors, coupled with pressure to reduce waiting times in GP clinics and the number of repeat patient visits, that has left prescribing strong pain relief medications as a ‘quick fix’ for some doctors.

Yet, the blame cannot simply fall on GPs – or any other healthcare professional.  PHE’s report demonstrates the need for every part of the health service to work collectively to create a holistic solution to pain management.

Not everyone with chronic pain will be able to communicate that pain and many will show no demonstrable physical manifestation of their pain. PHE’s report has brought the hidden facts about addictive medicines use into view, we must now do the same for the condition of chronic pain.

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